Health
Advisory
SALMONELLOSIS RISK ASSOCIATED WITH REPTILES

The Delaware Division of Public Health (DPH) wishes to alert the Delaware medical community about the risk of salmonellosis transmission
associated with handling reptiles. In Wisconsin, the state Department of Health and Family Services has identified 2 children sickened by
salmonellosis after handling small turtles illegally sold by vendors in four Wisconsin counties. At this time there are no known reptile
associated cases of salmonellosis in Delaware.

Background:

Salmonellosis associated with reptiles is a continuing public health concern. During the 1970s, small pet turtles were a major source of
Salmonella infections in the USA. In 1975, the FDA banned commercial distribution of small (less than four inches long) turtles.
Delaware prohibited the sale of such turtles. These measures prevented an estimated 100,000 cases of salmonellosis among children each
year in the United States. However, reptiles remain popular pets in the U.S. The increase in pet reptile popularity has been paralleled
by an increase in the number of reptile-related Salmonella serotypes isolated from humans.

Reptiles are commonly colonized with Salmonella and shed the organism intermittently in their feces. Attempts to treat reptiles
with antibiotics to eliminate Salmonella carriage have been unsuccessful and might lead to increased antibiotic resistance.
Salmonella survives well in the environment and can be isolated for prolonged periods from surfaces contaminated by reptile
feces. For this reason, even minimal indirect contact with reptiles can result in illness. For Salmonella bacteria to spread
from reptiles to humans, the bacteria must be ingested. Therefore, simply touching or holding a reptile will not result in spread of
bacteria unless something contaminated with reptile feces or the reptile itself is placed in the mouth. All reptiles should be presumed
to be carrying Salmonella in their intestinal tract and to be continuously or intermittently shedding it in their feces.

Clinical Description:

Most Salmonella infections in humans result in a mild, self-limiting illness characterized by diarrhea, fever and abdominal
cramps. However, the infection can spread to the bloodstream, bone marrow or nervous system, leading to severe, and sometimes fatal,
illness.

Risk Groups:

Those at increased risk for developing severe salmonellosis include the young, the elderly, pregnant women and those with weakened immune
systems.

Incubation Period:

Incubation period is from 6 to 72 hours, but is usually between 12 to 36 hours.

Period of Communicability:

Person to person communicability persists throughout the course of infection and is extremely variable. Occasionally a temporary carrier
state continues for months, especially in infants.

Laboratory Criteria for Diagnosis:

Salmonella may be isolated from stool specimens of both symptomatic and asymptomatic individuals (three to ten grams of fecal
material preferable to rectal swabs) inoculated into an appropriate enrichment medium. Specimens should be collected over days since
excretion of organisms may be intermittent. In cases of septicemia, Salmonella may be isolated on enteric media from feces and
blood during acute stage of illness. Serologic tests are not useful in diagnosis.

Bacterial culture of fecal specimens from reptiles to determine Salmonella infection status is discouraged. If veterinarians are
called upon to assist health officials in determining the cause of salmonellosis in a person, bacterial culture of combined fecal and
cloacal specimens from reptiles with which that person has had direct or indirect contact are recommended. Specimens should be collected
over days since excretion of organisms may be intermittent.

Prevention:

The spread of Salmonella bacteria from reptiles to humans can be easily prevented by the following routine precautions:

Always wash hands with hot, soapy water after handling reptiles, reptile cages and equipment, and the stool of reptiles.

Do not allow reptiles to have access to the kitchen, dining room or any other area in which food is prepared. Also, do not allow
reptiles to have access to bathroom sinks and tubs or to any area where infants are bathed. Consider keeping reptiles caged or limiting
the parts of the house where reptiles are allowed to roam free. Always wash hands after coming into contact with any area where reptiles
are allowed to roam free.

Do not eat, drink, or smoke while handling reptiles, reptile cages or reptile equipment. Do not kiss reptiles or share food or drink
with them.

Do not use the kitchen sink, kitchen counters, bathroom sinks or bathtubs to bathe reptiles or to wash reptile cages, dishes or
aquariums. Reptile owners may wish to purchase a plastic basin or tub in which to bathe or swim their reptiles. Waste water and fecal
material should be disposed of in the toilet instead of the bathtub or household sink.

The Centers for Disease Control and Prevention (CDC) recommends that children less than 5 years of age avoid contact with reptiles
and that households with children less than 1 year of age not own reptiles. The Association of Reptilian and Amphibian Veterinarians
encourages reptile owners with young children to discuss steps to minimize risks associated with owning reptiles with their reptiles'
veterinarian and their physician. Children should be supervised when they are handling reptiles to ensure that they do not place their
hands or objects that a reptile has contacted in their mouths. Reptiles should not be kept in child care centers.

Immunocompromised persons should avoid contact with reptiles.

Follow instructions from a veterinarian concerning proper diet and environment for your reptile. Healthy reptiles living in proper
environments are less likely to shed Salmonella bacteria.

Reporting of Suspect Cases:

To aid in surveillance, the Delaware Division of Public Health (DPH) requests that health care providers be suspicious of patients
presenting with clinically compatible illness and those having a history of contact with a reptile. Report suspicious cases and
laboratory confirmed salmonellosis infections to DPH, Bureau of Epidemiology at 1-888-295-5156. The number is available during normal
business hours and during non-business hours for emergencies.

For Further Information:

Gaps remain in the public's understanding of amphibian and reptile associated salmonellosis. Pet store owners, health care providers
and veterinarians should provide information and prevention messages about salmonellosis to owners and potential purchasers of reptiles.
Educational materials are available from the Pet Industry Joint Advisory Council, telephone 800-553-7387.

Questions about this health advisory can be directed to DPH, Bureau of Epidemiology at 1-888-295-5156. The number is available during
normal business hours and during non-business hours for emergencies.